January 1, 2005
Bringing New POCT Equipment on Board
Advance for the Administrators of the Lab –
Vol. 14, Issue 1
POC Connectivity Concepts,
When point-of-care testing (POCT) is to be implemented on a
large scale—involving multiple clinics and units or even
multiple hospitals—pre-planning by multidisciplinary teams is
essential. Equally important is to incorporate instrument
vendor expertise into the training process. Involvement at all
levels can help ensure that labs stay in regulatory compliance
and remain competent users of POCT equipment.
When dealing with quality control for employees new to the
instrumentation, Lou Ann Wyer, MT(ASCP), clinical specialist,
POCT/QM, Sentara Laboratory Services, Norfolk, VA, tells
ADVANCE that her facility conducts precision, reportable
range or calibration validation and method comparison studies
during the pre-planning phase. Statistical analysis is
performed on each set of data and the method's performance is
approved prior to implementation.
At Sentara, POCT staff and, occasionally, vendors, provide
initial training to POCT operators. Training sessions are
scheduled with input from nurse managers and are conducted
outside of the patient care workplace. "If staff have an
active role in the decisions for new instrumentation and work
processes, it will lead to a win-win situation for all," Wyer
Part of the training involves curbing errors such as
misidentification of specimens. To simplify identification,
Wyer says POCT operators have barcoded wristbands and operator
identification badges. She suggests that if a facility has not
yet converted to barcoded bands, the lab should be involved in
the selection process to assure bands suffice for POCT
technologies—another way to incorporate staff into the
training and decision-making process. "It is wise to pilot or
trial several wristbands to ensure they work as anticipated,"
To stay on top of new testing technologies and regulations,
she recommends that laboratorians read journals and visit Web
sites, join professional organizations and participate in
audioconferences and Web casts. The information that these
sources provide, Wyer says, can help POCT users stay abreast
of where POCT regulations are headed.
"With more instruments available for POCT, we must be diligent
and investigate thoroughly for the benefits and efficiencies
they will bring to the POCT program," Wyer says. "We must
continue to ask and expect vendors to produce methods that are
as precise and accurate as clinical laboratory
instrumentation. POCT programs must have mechanisms in place
to prevent patient care units from ordering any type of
instrument without laboratory approval. Monitoring multiple
devices for the same analyte can be a nightmare."
Planning Is Key
Like Wyer, Diana R. DeHoyos, BS, MT(ASCP), POC coordinator at
the University of Texas Medical Branch at Galveston, works
with staff during the pre-implementation phase of POCT.
She notes that if instrumentation is implemented on a large
scale where multiple clinics and units or multiple hospitals
plan to adopt the technology, then pre-planning by
multidisciplinary teams is key. She explains that
incorporating vendor manpower into the roll-out is "in the
[lab's] best interest."
On a small scale, the training process at her facility is
coordinated and arranged by POC staff directly with the area
nurse manager or a similar supervisor. This facilitates
scheduling, because training often calls for taking personnel
away from their patient care duties and use of unit space.
On another note, DeHoyos stresses the importance of error
prevention in providing safe, quality POCT results, and that
barcoding can aid in positive patient identification and
outcome. And to guarantee safety, she agrees with Wyer that
staying abreast of new technologies and regulations is
Help From the Vendors
Ron Blasig, director of Marketing at Abaxis (Union City, CA),
provides vendor input on the essentials of training on POCT
instrumentation, noting that POC personnel train nursing staff
on new technologies offered by his company. Abaxis is the
developer of Piccolo, a portable, broad-menu clinical
chemistry analyzer designed for near-patient testing.
"Training is the same, whether it is a physician, lab
director, lab technologist or nurse," he says.
abreast of new regulations, Blasig attends conferences on CLIA
regulations and updates. "I work hand-in-hand with COLA to
provide information on how the Piccolo complies with new
regulations. Abaxis provides customers who purchase a Piccolo
with a guide to lab quality compliance," he explains. This
document details a step-by-step procedure on how to meet the
new regulations for non-waived testing with backup for
compliance using approved NCCLS guidelines.
In this respect, Blasig says he is able to provide training
tips and help customers stay compliant.
Regardless of the scale of the implementation, however,
vendors often provide helpful training, competency assessment
tools and materials that complement existing ones, while
facilitating and standardizing implementation of new
technology. Some vendors offer the ongoing service of tracking
compliance with selected regulatory requirements as an
Matthew T. Patton is editor of ADVANCE for
Medical Laboratory Professionals.